Quality: A Perception Gap?

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For more analysis and a look at the complete survey results from all sectors, please visit our HealthLeaders Media Industry Survey 2009 Web page, which features downloadable reports covering CEOs, finance, technology, quality, marketing, health plan, physician, and community and rural leaders.

Leaders in the healthcare quality arena are a positive bunch when it comes to their assessments of their organizations, according to the quality portion of our survey. When asked to rate the quality of 11 aspects of their organizations—including medical quality, information technology, fiscal management, workplace morale, growth prospects, and a host of other areas—on a rating scale of very strong to very weak, quality leaders' top answer was moderately strong for every category.

Such optimism, however, also demonstrates a gap in perception between patients and the people charged with improving the quality of care provided to those patients, says David Shulkin, MD, president and CEO of Beth Israel Medical Center in New York City. "I am always impressed by the lack of agreement or alignment between those in the fields and the purchasers and consumers," Shulkin says. "A growing dissatisfaction with what healthcare provides from the external users was not evident in the survey."

Nevertheless, respondents—including chief quality officers, chief nursing officers, and other senior quality executives—offered positive assessments of various aspects of their organizations. Consider:

  • Ninety-two percent believe their board is at least somewhat involved in quality improvement efforts.
  • They are pleased with their executive leadership (85% said their CEOs were at least competent if not visionary).
  • Despite indications from some corners of the industry that some caregivers are reluctant to report quality violations to superiors, they are optimistic that quality programs requiring staff to report violations will work—in fact, 91% said they will work with the proper leadership support and the proper penalties for nonreporting.
  • In evaluating the effectiveness of eight measures in improving physicians' quality of care, quality leaders' No. 1 answer was "strongly effective" for three measures: "having more time to spend with each patient," "increased focus on preventive care and patient education," and "improved communication among physicians and hospitals." None of the eight measures earned a "not effective" rating as the most popular answer.

Quality respondents were not without skepticism in some areas, however. Despite a growing industry emphasis on high-tech solutions for quality challenges, for example, only 12% said that electronic medical records are vital to improving quality and patient safety, and 41% said EMR systems are either not important at all or nonexistent at their hospitals. And when asked about the best way for hospitals to combat the spread of infections, quality leaders offered a decidedly low-tech response: 72% said improved or increased hand washing.

Another ubiquitous industry buzzword, transparency, is also not being embraced to any extensive degree; when respondents were asked whether their organizations share a list of 13 kinds of data points online with consumers, only two data points—Centers for Medicare & Medicaid Services quality indicators and patient satisfaction/HCAHPS data—garnered "yes" responses from more than 25% of respondents.

"It's never hard when your data looks great, but it is hard when the data suggests that others are better," Shulkin says. "It takes a real philosophical commitment to do this; I think you are seeing that this commitment is currently with a few leaders, and others will follow as these examples show the impact of their leadership."

For the next HealthLeaders magazine story in this package, visit www.healthleadersmedia.com/industry_survey/marketing. For complete, detailed survey results, visit www.healthleadersmedia.com/industry_survey.

—Jay Moore

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